肋缘下腹横肌平面阻滞在开腹肝癌切除术中应用的效果评价

【目的】评价3种方式的肋缘下腹横肌平面（TAP）阻滞在开腹肝癌切除术中应用的效果。【方法】选择经右肋缘下反“L”切口进行开腹肝癌切除术的成年患者60例，根据局麻药注射位置的不同，随机分为一点法（A组）、两点法（B组）和多点法（C组）3组，每组20例。所有患者均在局麻下行超声引导双侧肋缘下TAP阻滞，A组在锁骨中线位置进行一点注射，B组分别在胸骨旁线和腋前线位置进行两点注射，C组在前正中线与腋中线之间进行多点注射。观察TAP阻滞的阻滞范围、起效时间、持续时间以及血流动力学和腹壁肌肉厚度的变化，记录TAP阻滞的操作时间和并发症发生率。【结果】①B、C组的阻滞范围大于A组（P<0.05），B、C组之间无统计学差异：C组T7～T11节段的阻滞有效率均为100%；B组T7～T10的有效率均为100%、T11为98%；A组仅T8和T9的有效率为100%，T7、T10和T11均低于60%。②B、C组TAP阻滞的持续时间长于A组（P<0.05），3组的起效时间无统计学差异。③开腹过程中，A组的平均动脉压和心率大于基础值（P<0.05），B、C组无明显变化。④TAP阻滞后3组患者的腹直肌厚度均变薄，但比较其差值组间无统计学差异。⑤A、B、C3组TAP阻滞的操作时间分别为（8.4±1.9）、（13.8±3.1）、（23.3±4.2）min，两两比较有统计学差异（P＜0.05）；所有患者均未发生TAP阻滞相关并发症。【结论】肋缘下TAP阻滞在开腹肝癌切除术中应用的效果与局麻药的注射位置有关，两点法的阻滞范围充分、操作时间较少，优于一点法和多点法。

Evaluation of the Efficacy of Subcostal Transversus Abdominis Plane Block for Patients Undergoing Open Liver Carcinoma Resection

【Objective】To evaluate the efficacy of three different methods of subcostal transversus abdominis plane（TAP）block for patients undergoing open liver carcinoma resection.【Methods】A total of 60 adult patients，undergoing elective open liver carcinoma resection through a“reverse L”incision below the rib bow，were enrolled. The subjects were randomly divided into three groups（20 cases in each），including Group A，B and C，according to the position of local anesthetic injection. All patients underwent ultrasound- guided bilateral subcostal TAP block under local anesthesia. The TAP injection was injected at the middle line of the clavicle in Group A；Two separate injections were at the parasternal line and at the anterior axillary line in Group B；Multiple injections were proformed between the anterior median line and the middle axillary line in Group C. After completion of TAP block，the onset time，duration，blocking extent，hemodynamics and abdominal muscle thickness were evaluated. The operating time of TAP block and incidence of complications were recorded.【Results】The blocking extent of Group B or Group C was greater than that of Group A（P < 0.05），with no significant difference between Group B and Group C. The duration of TAP block in Group B or Group C was longer than that of Group A，while the onset time was not significantly different between the three groups. The mean arterial pressure and heart rate during laparotomy were higher than the base value in Group A，while there were no evident changes in Group B and Group C. The rectus abdominis became thinner after TAP block in all patients，but there was no significant difference in muscle thickness change among the three groups. The operating time of TAP block in the three groups was （8.4±1.9），（13.8±3.1），（23.3±4.2）min，respectively，with significant difference between any two groups（P < 0.05）. None of the patients enrolled showed such complications as local anesthetic poisoning，abdominal wall hematoma，nerve injury， abdominal viscera injury，and puncture point infection.【Conclusion】The outcome of subcostal TAP block for patients undergoing open liver surgery is related to injecting position of anesthetics. Two- point-injection method is superior to one- point-injection method or multiple-point-injection method，for adequate analgesic extent as well as less operating time.